Thursday, April 16, 2009

ACC 2009---ADMIRE-HF

This probably won’t make prime time soon (due to low commercial interest) but it should. A simple and readily available nuclear scan is a powerful prognostic tool for patients with heart failure. According to a Medscape-Heartwire report on the presentation at ACC 2009:

…the composite end point, the first occurrence of NYHA heart-failure class progression, potentially life-threatening arrhythmic event, or cardiac death, as determined by an independent adjudication panel, occurred significantly more frequently in patients who had low uptake of the tracer.

…there were 51 cardiac deaths in the low-uptake group and just two in the higher-uptake group, and the negative predictive value of a high uptake for cardiac death over two years was 98.8%.

…the test was particularly effective in identifying those with the worst prognosis, with the group who were in the lowest 10% for uptake having a death rate 10 times those in the highest 20%.

What’s the radiotracer? It’s 123I meta-iodobenzylguanidine (MIBG) aka AdreView, the agent that’s been recommended for years for imaging of occult pheochromocytoma. As an analog of norepinephrine, it is taken up by cardiac sympathetic nerves and serves as an indicator of cardiac sympathetic nervous activity.

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About Me

Originally a traditional internist, I became a hospitalist in the early days of the “movement.” I'll be writing about clinical topics, mainly in hospital medicine. Occasionally politics and other stuff creep in. This content does not constitute medical advice (consult your physician) nor is it authoritative (check primary sources).